二维斑点追踪成像鉴别缩窄性心包炎及限制型心肌病

Differentiation of constrictive pericarditis and restrictive cardiomyopathy by two-dimensional speckle tracking echocardiography

目的 研究二维斑点追踪成像超声心动图技术鉴别缩窄性心包炎(CP)及限制型心肌病(RCM)的价值和定量指标.方法 入选经手术和病理证实的CP患者18例,经心肌活检和临床诊断的RCM患者14例及健康对照组19例.储存不同切面动态超声二维图像,分析收缩期峰值左心室径向应变、周向应变、长轴应变,以及旋转角度、净拧转角度等指标.结果 RCM组径向应变低于CP组[心尖水平:(14±7)％比(23±12)％,P<0.05;乳头肌水平:(16±7)％比(32±14)％,P<0.05;心底水平:(13±11)％比(20±8)％,P<0.05],且两组均低于健康对照组(P<0.05).RCM组长轴应变低于CP组[心尖水平:(-12±4)％ 比(-17±6)％,P<0.05;乳头肌水平:(-8±3)％比(-16±4)％,P<0.05;心底水平:(-6±3)％比(-16±5)％,P<0.05],且两组均低于对照组(P<0.05).左心室心尖、乳头肌、心底水平,RCM组与CP组周向应变均低于对照组(P<0.05),但两组间差异无统计学意义.左心室心尖水平,CP组旋转角度低于RCM组[(4±3)°比(7±3)°,P<0.05]和对照组[(4±3)°比(9±3)°,P<0.05],但RCM与对照组差异无统计学意义.CP组净拧转角度低于RCM组[(7±4)°比(12±5)°,P<0.05],且两组均低于健康对照组(P<0.05).净拧转角度鉴别RCM与CP的截值点为9°,敏感性72％,特异性76％.结论 RCM组径向和长轴应变低于CP组,而CP的净拧转角度及心尖旋转角度的降低较RCM更明显,净拧转角度鉴别RCM与CP有较好的敏感性和特异性.

Objective To study the application value and quantitative parameter of two-dimensional speckle tracking echocardiography in differentiating constrictive pericarditis ( CP ) and restrictive cardiomyopathy (RCM).Methods 18 CP patients confirmed by surgery and pathology , 14 RCM patients verified by endocardial biopsy and clinical data , 19 normal control subjects were enrolled .Left ventricular radial, circumferential and longitudinal strain and rotation degree and net twist were measured.Results Radial, longitudinal and circumferential strains and net twist in both RCM group and CP group were lower than in normal control.Radial strain in RCM group was lower than in CP group [apex:(14 ±7)％vs (23 ± 12)％,P<0.05; papillary muscle:(16 ±7)％ vs (32 ±14)％,P<0.05;mitral level:(13 ±11)％ vs (20 ±8)％,P<0.05].Longitudinal strain in RCM group was also lower than in CP group [ apex:(-12 ±4)％vs (-17 ±6)％,P<0.05;papillary muscle:(-8 ±3)％vs (-16 ±4)％,P<0.05;mitral level:(-6 ± 3)％vs (-16 ±5)％,P<0.05].Rotation degree of apex in CP group was lower than in RCM group [(4 ± 3)°vs (7 ±3)°,P<0.05] and normal control[(4 ±3)°vs (9 ±3)°,P<0.05].The cut-off value of net twist to differentiate CP and RCM was 9 degree with sensitivity of 72％and specificity of 76％.Conclusion Radial and longitudinal strains in RCM group were lower than in CP group while apex rotation degree and net twist were reduced more in CP group than in RCM group .Net twist has good sensitivity and specificity in differentiating CP and RCM .